腔内治疗腹主动脉瘤合并双髂总动脉瘤的疗效分析  

Analysis of curative effect of endovascular treatment of abdominal aortic aneurysm with common iliac aneurysm

作　　者：王磊[1] 管圣[1] 慈红波[1] 方青波[1] 戈小虎[1] WANG Lei;GUAN Sheng;CI Hong-bo;FANG Qing-bo;GE Xiao-hu(Department of Vascular Surgery,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院血管外科

出　　处：《中国血管外科杂志（电子版）》2019年第3期207-210,共4页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的总结腹主动脉瘤合并双髂总动脉瘤的腔内治疗经验。方法总结2016年4月至2018年11月新疆维吾尔自治区人民医院18例接受腹主动脉腔内修复术(EVAR)的腹主动脉瘤合并双髂总动脉瘤患者。其中6例双侧髂总动脉直径18~25 mm,选择合适口径的髂动脉分支支架完成传统EVAR;9例双侧髂总动脉直径≥25 mm,选择双侧髂外动脉作为锚定区完成EVAR,并行髂总动脉直径较大侧或合并髂内动脉瘤样变侧进行髂内动脉弹簧圈栓塞术;3例双侧髂总动脉直径≥25 mm,选择双侧髂外动脉作为锚定区完成EVAR,并行三明治技术单侧髂内动重建。结果腔内手术均获得成功,手术时间(120±35)min,出血量(100±40)ml。术中无即刻Ⅰ型内漏出现。1例双侧髂外动脉作为锚定区治疗患者术后发生臀肌缺血症状;3例三明治技术单侧髂内动重建患者中,1例髂内动脉Ⅱ型内漏发生,1例髂内动脉闭塞。术后随访3~32个月,平均10.3个月,无动脉瘤破裂,髂动脉直径无明显扩张。结论腹主动脉瘤合并双髂总动脉瘤患者根据髂总动脉直径选择合适的腔内治疗方法可达到理想的治疗效果,重建髂内动脉与否术后生活质量无明显差异。Objective To summarize the experience of endovascular treatment of abdominal aortic aneurysm with common iliac aneurysm.Methods The clinical date of 18 cases of abdominal aortic aneurysm combined with double iliac artery aneurysms who received endovascular aneurysm repair(EVAR)from April 2016 to November 2018 were analyzed.Six patients with common iliac artery of more than 18 mm but less than 25 mm in diameter were treated with traditional EVAR with proper iliac stent graft.In 9 cases,the diameter of bilateral common iliac artery was greater than 25 mm.Both external iliac arteries were selected as the anchorage area to complete EVAR.The internal iliac artery spring coil embolization was performed on the side with larger common iliac artery diameter or the side with internal iliac aneurysmal degeneration.In 3 cases,the diameter of bilateral common iliac artery was greater than 25 mm,and both external iliac arteries were selected as the anchorage area to complete EVAR,and unilateral internal iliac reconstruction was performed by sandwich technique.Results All procedures were successfully completed.The operation time was(120±35)min and blood loss was(100±40)ml.No typeⅠlendoleak was found intraoperatively.Gluteal ischemia occurred in 1 case after the treatment with bilateral external iliac artery as anchor area.3 patients with unilateral iliac sandwich technology dynamic reconstruction:1 case of iliac artery inⅡtype internal leakage occurs,1 case in the iliac artery occlusion.In the follow-up of 10.3(3~32)months,no ruptured aneurysm nor obvious dilatation of iliac artery diameter occured.Conclusion Patients with abdominal aortic aneurysm double iliac aneurysm treated with appropriate EVAR according to the diameter of common iliac aneurysm can achieve a satisfactory effect.There is no significant differece in quality of life for reconstruction of the internal iliac artery or not.

关 键 词：腹主动脉瘤 腔内修复 髂动脉瘤 

分 类 号：R65[医药卫生—外科学]